Provider Demographics
NPI: | 1629217872 |
---|---|
Name: | SHARMA, VINOD (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | VINOD |
Middle Name: | |
Last Name: | SHARMA |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | VINOD |
Other - Middle Name: | |
Other - Last Name: | SHARMA |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 1838 SQUIRREL VALLEY DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BLOOMFIELD |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48304-1146 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 248-537-3012 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1838 SQUIRREL VALLEY DR |
Practice Address - Street 2: | |
Practice Address - City: | BLOOMFIELD HILLS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48304-1146 |
Practice Address - Country: | US |
Practice Address - Phone: | 248-537-3012 |
Practice Address - Fax: | 248-537-3012 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2009-02-11 |
Last Update Date: | 2022-02-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | VS050478 | 207Q00000X |
MI | 4301050478 | 208VP0000X, 208VP0014X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |